i entered cases today...

today i actually got to do some hands-on data entry with michelle. and, i did it right! :)

i have a better understanding of the process now:

when you go to the hosptial, or get admitted through the ER, the hosptial sends notification to your insurance company. based on the reason for admittance the insurance company will allow you to remain an inpatient for a certain amount of time. well, we authorize that allowance and then direct the case to either a nurse who will follow up or keep the case "inhouse" for a couple days (meaning it doesnt go to a nurse until a few days later, depending on the situation...). daily you check to see if the patient is still an impatient and update the case, or you enter the discharge date and close out the case.

the information we enter goes to the nurse of whatever hospital. she will then look over the report and tend to the patients as necessary. if for some reason there is an error on our part , or the person was discharged but the hospital never notifeid us, the nurse will send back the report notating the changes needed. we then fix it in our system and send it back.

after the patient has been discharged the hospital will send the billing to the claims dept. the claims dept will then look in the system at our authorizations and bill accordingly.

for example, today there was a case where we got notification of a patient admittance at a hosptial on the 13th. well, they have 24 hours to notify the insurance company. if its after 24 hours the insurance company will only authorize 1 day. so the hospital won't get paid (cant bill the customer) for the other days he was an inpatient.

there are exceptions for surgeries and births and stuff like that. its all in how you enter the case in the system.

i really enjoyed what i did today. you have to pay close attention to detail, which i like. the office is divided up into teams of 4, each team deals with certain hospitals. our office actually handles facilities for 6 different states, so theres alot to keep up with. i'm not sure what team i'll be assigned to yet. i guess i'll be told that once i'm further along in the training. but so far i like what i'm doing!! its cool because everybody mainly keeps to themselves, listening to their music, and entering the data. since i'm not a very outgoing person and get very intimidated by people, i think i'll do just fine here!

the only problem is the commute..I HATE TRAFFIC!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
hopefully once i work the schedule i was told i'll be driving when traffic isnt so horrible. we'll see...

so anyway, thats the basic gist of the job.